Provider Demographics
NPI:1508454984
Name:TUCKER, JILL CHRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17676 BREAKAWAY ST
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2752
Mailing Address - Country:US
Mailing Address - Phone:407-484-5663
Mailing Address - Fax:
Practice Address - Street 1:17676 BREAKAWAY ST
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-2752
Practice Address - Country:US
Practice Address - Phone:407-484-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9497267163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical